Environmental Health Tracking & Biomonitoring Program
Summary: June 11, 2013 Advisory Panel Meeting
Advisory Panel: Alan Bender, Fred Anderson, David DeGroote, Melanie Ferris, Tom
Hawkinson, Gregory Pratt, Pat McGovern, Geary Olsen, Cathy Villas-Horns, Lisa Yost.
MDH: Jeanne Ayers, Mike Convery, Deborah Durkin, Betsy Edhlund, Tannie Eshenaur,
Carin Huset, Jean Johnson, James Kelly, Pat McCann, Jessica Nelson, Rita Messing, Paul
Moyer, Barbara Scott Murdock, Christina Rosebush, Jeannette Sample, Ed Schneider,
Blair Sevcik, Paul Swedenborg,
MPCA: Frank Kohlasch
MDA: Joe Zachman
Others: Rebecca Wood, Mankato State University
Legislative Update and Summary
Assistant Commissioner Jeanne Ayers gave the update; Assistant Commissioner Aggie
Leitheiser could not attend.
Jeanne reviewed highlights of the 2013 legislative bills relevant to the EHTB program.
These included…
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An appropriation of $313,000 for Fiscal Years (FY) 2014-15 to support a third
round of PFC biomonitoring in the East Metro. This effort will re-test
participants who had been biomonitored in two earlier biomonitoring projects
and will also expand the biomonitoring efforts to collect and assay PFCs in blood
samples from a wider range of East Metro residents.
An appropriation of $499,000 for FY 2014-15 to support health impact
assessments, biomonitoring, and community engagement to address chronic
respiratory burden in high-density urban areas and mercury levels in children
and newborns in Minnesota.
A law that provides authority for MDH to continue collecting, storing, using, and
disseminating biological specimens and health data for health department
program operations, public health practice, and public health oversight activities.
MDH must also develop and publish retention schedules for biological specimens
and publish an annual inventory of biological specimens, registries, health data,
and databases.
An appropriation of $100,000 for the biennium to enable MDH to track, respond
to, and prevent childhood lead exposure.
After Jeanne Ayers’s review of the new legislation, Jean Johnson introduced Pat
McGovern as the new Advisory Panel chair. Bruce Alexander has stepped down from
the chair’s position, but is still an active member on the panel.
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Progress and Next Steps in Newborn Mercury Biomonitoring
Jean Johnson briefly reviewed the Advisory Panel’s recommendations for further
mercury and PFC biomonitoring and summarized the status of current projects and
planning for new projects that will take place under FY 2014-15 state funding.
In earlier meetings, the panel had recommended that EHTB staff measure prenatal total
mercury exposure in matched pairs of umbilical cord and heel stick blood spots for…
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Direct comparison of blood spot concentrations to the EPA reference level
(based on cord blood measurement) to learn whether biomonitoring newborn
blood spots is appropriate for informing public health action & for use in future
biomonitoring studies;
Further laboratory work to refine and publish the laboratory methods is ongoing;
Planning for additional biomonitoring of newborns in other parts of the state will begin
with the discussion of recruitment methods in this meeting. In this meeting, Jean said,
Jessica Nelson will report preliminary results for the first comparison, the Pregnancy and
Newborns Exposure Study (See next section). Two other studies have been initiated,
one near the Riverside area of Minneapolis and one in southwestern MN and
southeastern SD, and will use existing newborn blood spots.
The panel also recommended a third round of biomonitoring of participants in earlier
East Metro PFC biomonitoring and in an expanded sample of residents, including
newcomers.
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Because of new state funding for this project, planning for the next phase of PFC
biomonitoring begins in July 2013 (See PFC Biomonitoring… below).
The Pregnancy and Newborn Exposure Study
Jessica Nelson presented preliminary results of the MDH EHTB collaboration with
University of Minnesota investigator Dr. Ruby Nguyen, the principal investigator for the
Minnesota arm of The Infant Development and Environment Study (TIDES). The MDH
add-on to TIDES collected both cord blood and newborn blood spots in order to
compare total mercury (Hg) levels found in paired newborn cord blood and heel stick
spots. The goal was to aid in the interpretation of blood spot results from the MDH
Mercury in Newborns in the Lake Superior Basin 1 pilot study.
The collaborative study also analyzed the cord blood for lead and cadmium and, later in
the summer, will speciate mercury in cord blood samples to ascertain the inorganic and
methylmercury content. The study is also analyzing TIDES questionnaire data to learn
1
Final Report to EPA: Mercury Levels in Blood from Newborns in the Lake Superior Basin (PDF:
2637KB/181 pages)
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whether demographics, behaviors, or other characteristics of the mother are associated
with mercury, lead, and cadmium levels in the newborn.
Pregnant women enrolled in TIDES during their first trimester visit to University-Fairview
Riverside Hospital in Minneapolis. In the third trimester, they were recruited and
enrolled in the MDH-TIDES collaboration. Of those approached, 76% consented and
gave biological samples. All cord blood samples were collected by the attending
physician at the birth of the babies, and the Riverside Laboratory measured the
hematocrit values for the cord blood. Extra newborn blood spots were collected when
newborn blood spots were taken for routine newborn screening. Cord blood and
newborn blood spots were sent to the MDH Public Health Laboratory for metals
analysis; in total, the study had 52 cord blood samples and 51 newborn spot samples.
Of these, 48 matched cord and newborn spot pairs were available Cord blood results
and letters of explanation were sent to TIDES, and the TIDES staff sent each baby’s
results to its mother.
Laboratory analyses detected mercury in 65% of cord blood samples, lead in 46%, and
cadmium in 67%. Only one baby had cord blood mercury above 5.8 µg/L, the
Environmental Protection Agency (EPA) reference level. None of the babies had lead
over the 5 µg/dL CDC reference level. And all the babies had very low cadmium results.
Only 16 babies had detectable mercury in both the newborn spot blood and in the
matched cord blood sample. Another 32 matched pairs had detectable mercury either
in the blood spot or cord blood. Overall, 61% of the newborn spot samples had no
detectable mercury, compared to 35% non-detects in the cord blood. This result
reflects a difference in detection limits between the two laboratory methods. In the 16
matched cord-spot samples with detectable mercury in both, cord blood mercury levels
slightly exceeded newborn spot mercury levels in most cases.
Jessica presented the results of two types of correlation analyses (Spearman and
Pearson) for three different sub-groups: all paired cord and newborn spot samples; all
paired samples in which mercury was detected either cord or newborn spot; and the 16
paired samples in which mercury was detected in both cord and newborn spot blood
(Table 1). She then asked panel members for advice about which correlation would be
most useful in presenting the data.
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Table 1. Cord-spot relationship: Correlation
Paired cord and NBS sample (n=48)
Hg detected in cord or NBS (n=32)
Hg detected in cord and NBS (n=16)
Spearman
0.67
0.58
0.58
Paired cord and NBS sample (n=48)
Hg detected in cord or NBS (n=32)
Hg detected in cord and NBS (n=16)
Pearson
0.89
0.88
0.93
r
r
p-value
<0.0001
0.0005
0.02
p-value
<0.0001
<0.0001
<0.0001
She then turned to data from the TIDES survey, including demographic data, seafood
meals per week, ecofriendly food consumption, and season of birth, to look for factors
that might be predictors of mercury exposure. Self-reported seafood consumption
yielded the strongest association with higher cord blood mercury levels; women who
reported eating seafood 2-3 times per week had geometric mean levels of 1.42µg/L
compared to women who reported eating 0 meals of seafood per week. The data also
suggested that graduate-level education and degrees and higher socioeconomic status
were somewhat associated with somewhat higher cord blood mercury levels. Limited
data made it difficult to look at differences in mercury levels by race/ethnicity and
socioeconomic status, as the majority of participating mothers were white (87%), had
relatively high household incomes, and were highly educated (24% had graduated from
college or technical school; 49 percent had some graduate work or a graduate degree).
Only three participants identified as minority ethnicity, two identified as “other,” and
two were unknown. The data suggest that women with graduate level education had
slightly higher cord blood mercury levels than women with a college degree or less.
The next steps will include an analysis of whether hematocrit modifies the relationship
between mercury levels in cord blood and newborn spots, a summary of results for the
MN EPHT website, and a draft of a paper for publication.
The questions she posed for the panel were the following:
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What implications do these results have for ongoing biomonitoring of newborns?
What additional information is needed?
Discussion
Pat McGovern asked whether anyone on the panel wanted to address the question of
using non-detects (levels below the method’s level of detection, or LOD) in the analysis
and correlation analyses. Tom Hawkinson said that one should not use non-detection
values (calculated as MDL/√2) 2 in calculating the rank correlations between paired cord
2
MDL/√2 is obtained by dividing the method detection limit (MDL) by the square root of 2.
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blood and newborn spot samples, as doing so contaminates the analysis. Noting that
using these values in the correlation analysis could reinforce a possible false
relationship, Tom recommended using the third correlation analysis, which includes only
the paired samples with detected data. Pat agreed. Tom added that the correlation is
higher for the Pearson coefficient when we look only at the detected data. Greg Pratt
said that he is uncomfortable imputing values below the level of detection. MPCA has
struggled with that issue for quite a while, he noted, and now offers some methods for
treating missing and non-detection values. He explained, it depends on what questions
you want to answer and what conclusions you want to draw, as to what technique is
best, but my first thought is to be skeptical because you are making assumptions about
your data. Although it sometimes is useful to compute a value below the LOD, he
prefers alternative methods. Alan agreed, saying that said you can force an artificial
relationship by doing using non-detects.
Alan added that, before we determine how to analyze non-detect values, we need to
address the biological and logistical questions about which blood samples we want to
collect in future biomonitoring projects. Do we want to use newborn blood spots or
cord blood samples? Is one sample cheaper to collect? Is another more valid? If the
cord blood and the newborn spots both show no detection of mercury, then it’s useful
to use the non-detects. But if we want a quantitative analysis of the data, we need to
use only the 16 paired samples with mercury detections in both samples. Jean agreed:
for future biomonitoring, what question are we answering? Should we proceed by
collecting newborn blood spots, cord blood, or both?
“Why are there differences between cord and newborn spot blood?” Alan asked. Jessica
said that the cord blood is sampled from the umbilical cord just after the birth, and the
newborn blood spots are collected up to 24 hours later. She wondered whether, even
in that short time, mercury could be excreted or sequestered. She added that the
program would be receiving matched cord and newborn spot blood, and some maternal
blood specimens from the South Dakota State University National Children’s Study
Vanguard site in western Minnesota/eastern South Dakota. These can give more data
to help answer these questions.
Lisa Yost asked, isn’t the issue whether we can use newborn spots for primary screening
instead of cord blood? Jean agreed that the larger question is whether using newborn
blood spots is valid for population health surveillance via biomonitoring, given that
sampling cord blood is more expensive. Jessica added, we want to be able to study
trends [of mercury or other analytes] over time and compare exposures in population
sub-groups.
Greg asked about the relationship between maternal blood and cord blood. Agreeing
that mercury levels vary between maternal blood and cord blood, Jessica asked the
MDH Environmental Health staff for comment. Pat McCann, MDH Fish Consumption
Advisory Program director, responded that mercury concentrations in maternal blood
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can vary greatly from mercury concentrations in cord blood. The average cord:maternal
blood ratio is about 1.7, but can be as high as 6.0. She also noted that looking at the
hematocrit values for cord blood could help explain some of these differences. She
added that Grandjean 3 had recommended that looking at hematocrit could help address
that question. And, as Jessica reported earlier, that is part of the plan in this pilot study.
Pat McGovern said that she is working with a neonatologist in Pediatrics at the UMN
who studies iron deficiency in newborns and might be able to provide some insights on
these questions.
Turning attention to the second question, Pat McGovern asked whether staff might do
any GIS (Geographic Information Systems) investigations on geographic location of the
mothers’ neighborhoods, as that might be relevant and interesting—especially as we
add more numbers through other projects.
Jeanne Ayers commented on the use of the word, “seafood,” in the survey questions,
rather than the word “fish.” Pat McCann said that, in Minnesota, people don’t think of
seafood as fish. Jessica agreed that this wording is a limitation in the way the larger
TIDES projects asked the question in the survey. Tom said that many people don’t see
canned tuna as either fish or seafood. And Greg urged staff to ask about all three
categories—fish, tuna, and seafood—in future surveys.
Finally, Alan Bender encouraged staff to publish these findings in the peer-reviewed
literature. He acknowledged that staff aren’t given time to do this, and that they
needed to write papers on their own time. But, he stressed, it’s imperative that these
results get into the literature.
Recruitment & Consent for Pregnant Women and their Newborns
Recruiting and obtaining consent to study pregnant women and their newborns poses
challenges that range from identifying women in their early months of pregnancy to
ensuring that participants in the study represent the diversity of the larger population.
These presentations report experiences from three different activities: the EHTB pilot
projects, The Infant Development and Exposure Study (TIDES), and the National
Children’s Study (NCS).
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Jean Johnson briefly reviewed methods used for recruitment and consent in
three EHTB pilot projects, along with the participation rates obtained with each
method.
Pat McGovern compared and contrasted several methods used in the NCS to
identify, recruit, and obtain consent from pregnant women using a probabilitybased sampling approach and discussed the strengths and shortcomings of each.
3
Philippe Grandjean, University of Southern Denmark, an expert on health risks from prenatal exposure to
methylmercury.
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Ruby Nguyen was scheduled to review the methods used for clinic-based
recruitment and consent in the TIDES project, both in Minneapolis and in sister
TIDES studies elsewhere in the US. She was to review the protocol from out of
state, and EHTB staff were unable to make the telephone contact work. This
protocol will be presented in the next Advisory Panel meeting on October 8,
2013.
EHTB Pilot Project Recruitment & Consent of Pregnant Women, Newborns, & Children
Jean reviewed recruitment and consent methods and the participation rates obtained
for each of three EHTB pilot projects. Each pilot used a different approach to recruiting
and obtaining consent from the participating women. Participation rates ranged from
44-65% of those who were identified, invited, and who subsequently gave consent.
These pilots were highly effective in providing lessons for the best recruitment and
consent methods for larger studies.
The Minneapolis Children’s Arsenic Study used household-based recruitment of families
with children age 3-10 over a three-month period. The recruitment goal was to obtain
urine specimens from 100 children. The study targeted homes with known soil arsenic
concentrations above a background level. The approach was door-to-door with
advanced mailings in English and Spanish. Somali or Spanish speaking recruiters visited
homes as needed. The project offered gift cards to local stores as incentives. Despite
identifying and attempting to contact 883 households, staff were able to recruit only 40
children from 47 households.
Expanded recruitment through invitations to participate mailed to 2652 households in
the study area enabled staff to recruit 25 additional children. From all households that
responded, staff identified 119 eligible children, but only 65 consented and provided
urine samples. Overall, Jean said, the approach was costly in staff time and not likely to
be cost-effective for larger studies.
The Riverside Birth Cohort Study of Pregnant Women used mail and clinic-based
recruitment of pregnant women already enrolled in a birth cohort study. The goal was
to recruit 100 women (including 30 Hispanic and 30 non-Hispanic black) for urine
sample collection and testing for bisphenol A and four parabens. Gift cards were
offered as incentives.
Of 122 women contacted, 79 (65%) consented, and 66 provided a urine specimen. Very
few Hispanic women visited the clinic. Special efforts to recruit Somali women with
translated materials were unsuccessful. Only 4 Hispanic and 8 African American
women participated.
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The Lake Superior Mercury in Newborns Study 4 selected recent newborns from the
newborn screening database. So as not to stress the parents, MDH excluded about 10%
of newborns because of pregnancy complications, the infant's death, or health
problems. Another 25% of potential participants were excluded because of poor quality
or insufficient blood in the heel-stick blood spots. Staff then recruited newborns by
mailing a letter explaining the study, a consent form, and a brochure about safe fish
consumption to new mothers after they gave birth. Of all the Minnesota mothers
contacted, 1,130 (44%) returned the consent forms and agreed to participate.
Recruitment & Enrollment of Pregnant Women:
The National Children’s Study Vanguard Study
Patricia McGovern reviewed the four strategies for recruiting women into a pregnancy
cohort that were tested in the National Children’s Study. All used a probability-based
sampling approach, including:
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Household-based (Original Vanguard Study, or OVS)
Enhanced Household-based Recruitment (EHBR)
Provider-based Recruitment (PBR)
Direct Outreach (i.e., High-Low Intensity).
The OVS used a household-based approach with broad community engagement to
create awareness of the study, followed by mailings to all households in randomly
selected neighborhoods. The mailing informed households of the study and alerted
families when study staff would be in their neighborhoods. Study staff went door to
door to identify households with age-eligible women, interview them for study
eligibility, and invited those eligible to participate in the study. Results from 18 months
of recruitment in 7 study centers found that only 10% (N= 3,100) of the 30,900 women
screened met the criteria of being pregnant or trying to conceive; 63% (N=1950) of
these eligible women consented to participate.
These results led the National Children’s Study Program Office to contract with 30
additional Study Centers to test three alternative recruitment strategies.
The EHBR Strategy hired study staff from the neighborhoods where the potential
participants lived, intensified advertising, media (radio and television ads); and used
more community engagement practices. Over a shorter recruitment period (14 months
vs. 18 months), this strategy slightly increased identification of eligible women
4
The “Mercury in Newborns in the Lake Superior Basin” study was conducted by the MDH Environmental
Health Division from 2007 to 2011, in collaboration with state newborn screening programs in Minnesota,
Wisconsin, and Michigan. It was primarily funded by the U.S. Environmental Protection Agency (EPA), with
additional funding provided by the MDH Division of Environmental Health and the MDH Environmental
Health Tracking and Biomonitoring Program.
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(pregnant or trying to conceive) from screening to 13% (from 10% in the OVC) and
enrolled 63% of eligible women, comparable to enrollment percentages in the OVC.
The PBR Strategy identified prenatal care providers in a specific county to identify
women who lived in randomly selected neighborhoods and then recruited women from
those providers using mailings and follow-up calls. Using the same 14 month
recruitment duration as the EHBR approach, this method greatly increased identification
of eligible women (pregnant or trying to conceive) from screening to 76% (vs. 10% from
OVS and 13% in EHBR), and enrolled higher percentages of eligible women with
consents at 76% (vs. 63% in the OVC and EHBR).
The Direct Outreach approach used broad community outreach county-wide, plus
intense outreach in randomly selected neighborhoods to create awareness of the study.
Then household mailings were sent to all listed addresses in the selected neighborhoods
to invite residents to call the study center if there were age-eligible women in the
household to see if any that were study eligible. During 11 months of recruitment, this
method identified 18% of eligible women (pregnant or trying to conceive) from
screening (vs. 10% from OVS, 13% from EHBR, 76% from PBR), and enrolled 80% of
eligible women (vs. 63% in the OVC and EHBR, 75% from PBR).
The Direct Outreach approach reported the highest proportions of women who spoke
English, had college degrees, were married, and were 25 years or older. This outcome is
associated with a recruitment strategy that requires women to take the initiative to
contact study staff for eligibility screening.
The provider-based sampling was the most efficient of all of the recruitment methods
tested. It led to:
• The highest yield of pregnant women
• The lowest yield of preconception women
• The highest rate of enrollment for pregnant women
• One of two highest rates for enrollment of preconception women.
The accompanying biases for the provider-based sampling were the following:
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Slightly more non-Hispanic blacks, slightly fewer Hispanics compared to countylevel population data
Slightly more women of 25-34 years and < 24 years compared to county-level
data, and relatively fewer women 35 years of age and older compared to county
level data.
Proportion of married women and partnered women almost comparable to
county-level data.
Pat then briefly described a multi-stage probability sampled birth cohort that would use
the provider-based recruitment strategy. The approach would create a geographic
frame and probabilistically select areas with about equal numbers of births and sample
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systematically from hospitals, birth centers, and other prenatal providers. The method
would also target underrepresented women of scientific interest.
Discussion
Jean Johnson asked the panel, what are the takeaway messages for biomonitoring?
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What can MDH-EHTB learn from the NCS and TIDES study protocols that will
guide future protocol decisions in MN?
Can a clinic-based protocol address issues of participation bias for surveillance
purposes?
Are results likely to be generalizable?
Are minorities likely to be represented?
Alan commented that, to control biases, in the transition from research to the
identification of problems that need to be detected on a population basic, data must be
reportable without consent. None of these strategies for recruiting pregnant women
will give an unbiased result as mandatory reporting does for public health surveillance.
Opting into or out of reporting introduces bias into studies. If we know that it’s
important to identify mercury in newborns statewide, for example, the exposure ought
to be a reportable condition. Routinely collected data should be available to study, as
cancer or food poisoning data are, he argued; look at the efforts involved in recruitment
of participants for studies.
Noting that research studies always require informed consent, Pat McGovern
commented that taking baby steps might be useful before making an all-or-nothing
decision about this. It would be an enormous request to ask for mandatory reporting.
Fred Anderson said that there are other ways to study portions of the population, such
as settlement houses or local communities, but each has its drawbacks—
socioeconomics, or geographic areas—so all studies have biases. Alan said we should
not make new requests, but use existing data reporting systems; if heel sticks are
collected on every baby, we should be able to use those spots to identify problems in
the population. Jean added, under current law, I do not see how we will ever get to use
existing specimens without consent. We will always have bias in recruitment for
studies; given the privacy laws we have today, we always expect to have to obtain
consent for biomonitoring; and we will always have to manage and explain bias. Pat
McGovern pointed out that the provider-based model seems to be very effective in
recruiting women for studies. And Melanie Ferris suggested that, to prevent bias
toward higher socioeconomic study participants, studies of pregnant women and their
babies could also work with such agencies as WIC clinics and community-based clinics to
reach more diverse, underrepresented women.
Pat McCann, MDH Fish Consumption Advisory Program director, asked about the
participation rates for requests to use newborn blood spots in Logan Spector’s Riverside
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study and the National Children’s Study. Neither Pat McGovern nor Jessica Nelson knew
those rates off the cuff, but Pat McGovern estimated that the NCS rates were about
67%. Pat McCann replied that, according to Alan, the participation rates used to be
around 80%. What has changed? What do we expect now? Lisa wondered how other
states deal with the problem, but added that, overall, the population has changed—it is
now less homogeneous, and people may not trust their institutions as much. For each
community one needs to work with insiders, but how well that works can vary. Pat
McGovern pointed out that the provider-based approach they used led to a 78%
recruitment rate—close to the earlier 80% rate. Jean added that studies can use the
approach used in the NCS—comparing data from recruited participants with the census
data, to identify whether and where there are biases.
Biomonitoring updates
Jean Johnson expanded on two of the updates. The first was the Biomonitoring Summit.
This one-day event convenes leaders in state biomonitoring and Minnesota
stakeholders to share accomplishments from Minnesota’s biomonitoring program, to
learn about biomonitoring programs in key states, and to develop an expanded vision
for biomonitoring’s future in public health improvement in Minnesota. As of June 11,
the day of the Advisory Panel meeting, staff had recruited speakers from Wisconsin,
California, and Washington State to discuss their state biomonitoring programs, and
over 60 people had registered for the conference.
She also gave a brief update on the East Metro PFC Biomonitoring Follow up Project
Community meeting held in May to discuss the project’s findings with participants,
community members, local public health officials, legislators, and other key
stakeholders. About 40 people—community members and stakeholders—listened to
the presentations and took part in discussions during and after the event. The next
steps are to discuss the results of the project with local health providers and to
complete an update of cancer rates in Washington and Dakota Counties and to make
the analyzed information available to residents of those counties.
No other updates were discussed.
PFC Biomonitoring Goals for an Expanded Sample (PFC3)
Jessica set the stage for the discussion of how to set the goals of the next East Metro
PFC project. As recommended by the Advisory Panel, she said, the final FY 2014-15
Minnesota State budget includes two years of funding for a third round of PFC
biomonitoring in the East Metro. This follow-up project has two components:
1) Re-contacting participants in the two earlier biomonitoring projects for
consent to collect a third blood sample (164 people took part in the 2010
project).
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2) Expanding the sample to include about 200 additional people from the East
Metro who are not necessarily long-time residents (long-term residence was
one criterion for the earlier biomonitoring projects).
To plan this next round of PFC biomonitoring, Jessica requested Advisory Panel advice
and suggestions on the goals for measuring PFCs in the expanded sample of participants
(group #2, above). She listed a few possibilities for discussion:
• Assess exposures in a representative sample of East Metro residents, including
both long-time and newer residents.
• Assess exposures in newer residents of these communities, i.e., people who
moved to Oakdale, Lake Elmo, or Cottage Grove after Jan. 1, 2005, when
remediation measures began to reduce PFC levels in drinking water.
• Respond to legislative interest in measuring PFC exposures in children and in
certain potentially vulnerable groups (including farmers in the area).
• Some combination of the above.
To address the question of biomonitoring children for PFCs, Christina Rosebush
reviewed what is known about children’s PFC exposures, measured as serum
concentrations of PFCs. She used data from published biomonitoring studies (Olsen
2004,5 NHANES,6 Emmett et al.7, ) that measured PFCs in children. In the Olsen study
of 598 children in a multicenter trial, the youngest children, because of their hand-tomouth behavior, had higher 95th percentile estimates for PFHxS and M570 (a precursor
to PFOS) than adults. In children aged 2 years to 12 years, PFOA and M570 levels were
higher in the youngest children in that range than in the oldest. In the NHANES study,
which had pooled serum data from 2001 and 2002 for children, adolescents, and adults,
mean concentrations of PFCs in the young children’s pools were higher than in
adolescents and adults. Studies of PFOA exposure in the C8 Study in West Virginia and
Ohio found that residents over 60 years of age had significantly higher serum PFOA
levels compared to all other age groups except children aged 2 to 5 years old. This may
be because these age groups are more likely to be at home and drinking water at the
home.
Jim Kelly discussed the question of biomonitoring local East Metro farmers, including
the Hmong truck farmers who supply the Farmers’ Markets. The public concern
expressed was that PFCs in area landfills might have contaminated irrigation waters for
crops or that PFCs could have volatilized from a spray system used to remove volatile
organic compounds from a particular contaminated landfill. MDH’s Environmental
Health (EH) Division staff concluded that the older types of PFCs in that landfill are not
5
6
7
Olsen, G.W.; Church, T.R.; Hansen, K.J.; Burris, J.M.; Butenhoff, J.K.; Mandel, J.H.; Zobel, L.R. Quantitative Evaluation
of Perfluorooctanesulfonate (PFOS) & Other Fluorochemicals in the Serum of Children. Jour. Children’s
Health. 2004, 2(1), 53-76.
Kayoko Kato; Lee-Yang Wong; Lily T. Jia; Zsuzsanna Kuklenyik; Antonia M. Calafat; Environ. Sci. Technol. 2011, 45,
8037-8045
Emmett EA, et al., Community exposure to perfluorooctanoate: relationships between serum concentrations and
exposure sources. J Occup Environ Med. 2006 Aug;48(8):759-70
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volatile, so were unlikely to contaminate nearby crops. Because residents had gardened
for many decades in the area, EH staff performed the PFCs in Homes & Gardens Study
near the disposal sites where crops had been irrigated with contaminated water. The
study found that soil levels were well below residential soil reference values established
by the Minnesota Pollution Control Agency; only low levels of PFCs were found in the
produce that was tested. 8 Other farm fields are irrigated with well water that is not
contaminated, so MDH staff concluded that neither current farmers nor their crops are
being exposed to PFCs at levels of concern.
Fred asked whether Jim was talking about truck farmers, such as Hmong farmers. Jim
said, yes.
Discussion
Jessica asked the panel to consider the questions posed in the background book:
•
•
Do panel members have a recommendation about the goal of the expanded
sample?
Should children or other special groups be targeted?
In addressing the goal, Alan began by asking how children had been studied in other
projects, specifically Geary Olsen’s study of PFCs in children. Observing that the Olsen
study had used existing samples of children’s blood for the PFC study, he said that MDH
doesn’t support taking blood samples from infants, unless doing so offers an important
benefit to the child. Geary said that the two chemicals tested (PFHxS and M570) were
used in Scotchguard-like applications to carpeting. His study found that very young
children’s higher exposures reflected their behavior patterns, such as hand-to-mouth
activity and playing on the floor. Older children had less exposure. NHANES
subsequently also reported this pattern of exposure. Given 3M’s phase-out of PFOS, it is
uncertain whether this pattern of exposure to PFCs in carpet continues.
The East Metro exposure concern is different, he said, it’s water-based exposure. MDH’s
PFC exposure studies focused on drinking water exposure because the likely source was
water. The question about adding children asks, is there something different in children
that we want to understand that is based on water exposure?
Fred pointed out that the children of new residents have all been exposed to East Metro
water since 2005. And because mitigation of PFCs in drinking water began in 2005, most
East Metro children should not have high PFC levels from the water. Lisa commented, it
really would not make sense to biomonitor children, since the likelihood of current
exposure is very low, now that the water contamination has been reduced. This implies
8
Perfluorochemicals (PFCs) in Homes and Gardens Study. Status report in December 2012 Advisory Panel book,
MDH EHTB program, December 2012.
http://www.health.state.mn.us/divs/hpcd/tracking/panel/2012decmaterials.pdf
75
that newer residents—those who moved in after treatments to reduce PFCs in the
water began—should have low PFC levels that are similar to those in the general
population.
For clarification, Greg Pratt asked, was the intent of the legislation aimed at learning
about the water-PFC exposure or was it intended to identify all sources of exposure?
Geary said, the panel’s recommendation to biomonitor new residents was made to
capture people exposed only to the recent—mitigated—PFC water levels. Jessica
concurred. The driving reason is to make sure the blood levels are still coming down in
the older population and that the new population should not have very elevated levels,
more than the general population.
Jean said that, in testimony at the legislature, she had explained the Advisory Panel’s
recommendation to expand the population sample in the East Metro. 9 The purpose of
the third round of East Metro PFC biomonitoring is to assure legislators and East Metro
residents that PFC levels in older residents are still declining and that newer residents—
those who moved into the East Metro after treatments to reduce PFCs in the water
began—are likely to have PFC levels that look like those in the general population. The
goal is to assure residents that this history of [drinking water contamination] caused PFC
exposures in the residents and that the measures taken to reduce PFCs in the water
have worked. Because some legislators then asked whether we were planning to test
children and Hmong farmers, we want to make sure the panel still agrees with the
original goal.
Melanie raised another reason to focus only on adult East Metro residents. The budget
for the extended sampling would only allow about 200 participants. Does this study
population have room to include children or other groups? If the population sample is
diluted by groups other than adult East Metro residents, the study won’t be large
enough to provide the assurance that the third round of biomonitoring in expanded
samples of the population is supposed to address. Tom and Alan agreed that the
program would dilute the sample if it included other groups. And, Fred Anderson
added, for the Washington County Local Public Health Department, the goal is
assurance.
9
In September 2012, the EHTB Advisory Panel recommended that MDH should pursue continuing PFC monitoring in
the same participants and should expand the sample in the East Metro area so that a full range of current adults,
including newcomers, are represented. Because the efforts to reduce PFCs in drinking water began in 2006, younger
residents, and especially newcomers, are likely to have PFC levels that are more like the background levels seen in
national surveys. Continued biomonitoring in the community would provide further assurance that the actions still
being taken to protect public health are successful. Minnesota Environmental Health Tracking & Biomonitoring
Report to the Legislature, p. 25. January 2013.
http://www.health.state.mn.us/divs/hpcd/tracking/pubs/ehtblegreport2013.pdf
76
Pat McGovern summarized the discussion, saying, it seems that the Advisory Panel
members want to stay with the original intent. Panel members agreed. To address
legislators’ interest in other groups, Melanie suggested that staff summarize the
literature on what is known about this group of farmers and about children’s exposure
to PFCs and then, in the report on this study, explain why MDH did not include them.
Finally, Jessica asked the panel to consider the sampling frame: Should we sample new
residents separately or take a representative sample of all adults that could be stratified
later to look at newer residents and older residents independently?
David DeGroote said that two hypotheses (declining PFCs in old residents and limited
PFC exposure in new residents) require two samples of the population. What’s
happening in new residents requires a sample of new residents, while following up on
an existing cohort requires another round of sampling. Geary asked, are you planning
on sampling in parallel or almost sequentially? Recruiting 200 new participants will take
some time, whereas you can re-sample the old cohort (164 participants) anytime. Jean
asked whether seasonality is important, as well as population. Jean said she heard a
consensus to focus only on adults and on a mix of newer and older residents. All agreed.
Geary then suggested that staff might recruit more long-term residents into the new
sample and frequency-match them to the existing population to make comparing their
PFC levels to the original studies more interpretable.
New Tracking Content: Arsenic in Private Wells
Background
The MDH Well Management Section and the MN Tracking Program have been
collaborating to develop and pilot new tracking content for arsenic in private wells. The
work included participation in the CDC Tracking Program Private Well Taskforce, which
had members from several states and CDC. In March 2013, the Taskforce published a
new guidance for states interested in developing measures for arsenic in private wells.
Taskforce members identified arsenic as a top priority and listed several other chemicals
of interest (nitrate, pesticides, VOCs).
The Taskforce also published a white paper with information and recommendations for
states that want to add private well questions to their module of the Behavioral Risk
Factor Surveillance Survey (BRFSS). BRFSS is a cross-sectional telephone survey
conducted by state health departments with technical and methodological assistance
provided by the CDC. States can add questions to the survey for a fee. MDH has
successfully added environmental health questions about private wells (testing), radon
(testing), and carbon monoxide alarms to BRFSS in the past, but these questions have
not been repeated in recent years.
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Presentation
Ed Schneider, a hydrologist in MDH’s Environmental Health division, presented findings
from the MN Tracking program’s Evaluation Template and displayed a series of pilot
maps of selected data on arsenic in private wells, dating from mid-2008 through January
of 2013. (Please see the June 2013 Advisory Panel background book to see the
Summary of Evaluation Criteria for a New State-Specific Tracking Content Area.) Since
2008, Minnesota Administrative Rules require that new wells be tested for arsenic, with
results reported to MDH.
One million residents of Minnesota—20% of the population—rely on private wells for
their drink water. Moreover, Ed explained, although MDH recommends that all well
water should be tested, no enforceable standard for arsenic in private wells applies in
Minnesota, aside from the 2008 requirement that new wells be tested. An estimated
500,000 wells were constructed before 2008, and many of them have never been tested
for arsenic. A 1994 CDC study of a representative sample of private wells in Minnesota
calculated that 14.7% of private wells contain arsenic above 10 µg/L of water, the
maximum contaminant level (MCL).
Arsenic is common in Minnesota groundwater, but is more likely to be found in areas
that were glaciated in the past. The largest and most recent of these is the Des Moines
Lobe (Figure 1). 10 Glacial till deposited by the Des Moines Lobe contains fine silts and
clays with arsenic adsorbed to the exterior of the sediment grains. 11 In places, the till
also has geochemical conditions favorable to release of the adsorbed arsenic into
groundwater. Arsenic that is part of the mineral matrix in the Des Moines Lobe till and
in other soils, is much less likely to be mobilized.
Figure 1.
MDH recommends that Minnesota residents with private wells should have the water
tested for arsenic and should make sure that the arsenic levels are < 10 µg/L. MDH
Well Management notifies all well owners with reported arsenic >2 µg/L. Ed said that
arsenic is highly soluble, tasteless, and odorless. It is fatal at doses of 60 mg or more,
10
Krippner, Mark. The Glacial Landscape of Minnesota. Quaternary Geology ES 767. November 2011.
http://academic.emporia.edu/aberjame/student/krippner1/minngeo9.htm
11
Erickson and Barnes. 2004. Arsenic in Groundwater: Recent Research and Implications for Minnesota. CURA
Reporter 34 (2): 1-7. Center for Urban & Regional Affairs, University of Minnesota.
78
but that arsenic levels above the MCL of 10 µg/L in drinking water can contribute to
chronic diseases. People who have drunk well water containing greater than 10 µg/L of
arsenic for many years have a greater risk of lung and bladder cancers than the general
population. Some evidence suggests that arsenic concentrations as low as 3 µg/L in
drinking may also contribute to chronic illnesses.
Ed next listed the public health actions that well owners could take to protect
themselves:
1) Have the well water tested
2) Use a good filtration device to remove the arsenic
3) Connect to a safe water supply, such as a community water supply that is tested
and treated to reduce arsenic and other contaminants.
He walked panel members through several of the maps, from those that showed the
number of new wells in each county or township and the percentage of the wells that
contained arsenic above 10 µg/L, to maps of individual wells sampled in Minnesota or in
the Des Moines Lobe region (Minnesota, Iowa, and North and South Dakota) with
arsenic concentrations > 10 µg/L and < 10 µg/L. For more, please see the Advisory Panel
book for June 2013.
Chuck Stroebel then presented draft BRFSS questions about private wells. The
questions asked whether the respondent had a private well, whether it had been tested
for arsenic and nitrate, and when.
Questions posed to the panel were…
• Do panel members have suggestions for improving the display and interpretation
of private wells data?
• What audiences or partners might be interested in using these data? How?
• How might the collection of BRFSS data add value to the piloted measures (to
inform public health action)?
Discussion
Geary asked about the costs of remediation for wells with arsenic contamination. Ed
described the costs of several effective treatments: reverse osmosis units under the
sink, about $1000;
treatments that use absorptive media, such as iron oxide minerals, cost about $100$300. Pat McGovern asked about maintenance costs, and Mike Convery, a hydrologist
supervisor in the Environmental Health Division, replied that filters must be replaced
periodically, and the frequency of replacement varies by the filter.
Greg suggested that the group consider some other ways to analyze the data, such as
using kernel density surface smoothing for maps or correlating the data with digital
maps of soil and bedrock geology. He also asked about the effects of well depth. Ed
79
replied that well depth is probably relevant, but that no correlation has been observed
between the depth of a well and its arsenic concentration. Arsenic levels are often
higher in a well that draws water from the top of a confined aquifer, just below a clay
confining layer. Water drawn from an unconfined aquifer, above the clay layer or from
deeper in the aquifer and farther below the clay layer, tends to have lower arsenic
levels. So it’s hard to predict how depth will affect the arsenic level in well water. Mike
added that arsenic levels are very sensitive to the particular environment where a well is
constructed; two wells that are close together may contain water with completely
different arsenic concentrations.
Melanie asked about the audiences the well program was trying to reach; are you trying
to persuade residents with older wells to re-test the water? Fred said that realtors,
well drillers, homeowners, and water filtration companies would all be relevant
audiences.
Lisa asked about the range of typical arsenic concentrations in wells and whether or
how the levels vary over time. Ed said that a few wells have been found to have levels
around 200 µg/L, but that 100 µg/L is the usual worst case end of the range. Mike
added that, although he isn’t sure, he doesn’t expect major variations in arsenic levels.
He also said that the program had received extra funding for follow-up testing, since
most testing of new wells happens right after the wells have been drilled, so the tests
don’t reveal the long-term picture.
Cathy suggested that the well program might consider hosting testing clinics, so people
can bring in water samples and get arsenic testing results on the spot. The testing
clinics could be like those held by the Minnesota Department of Agriculture to test for
nitrate in private wells.
The discussion then moved to considering the maps. Melanie suggested that the staff
should be very thoughtful about titles, and suggested that the maps include the number
of wells that exceed the 10 µg/L maximum contaminant level (MCL), not just the
number of wells tested. Pat McGovern suggested that staff convene a users’ group of
local public health staff to test the maps and provide map-messaging feedback.
Pat also addressed the BRFSS questions, asking whether it would be possible to ask
questions about more metals in the water, not just arsenic. She suggested using the
CDC Task Force’s (?) list of the top 10 contaminants in water to identify the metals of
interest. [Note: the list includes manganese (Mn), radionuclides (of uranium or radon,
for example), nitrate (NO3), volatile organic compounds (VOCs), bacteria, pesticides, and
perchlorate.] Chuck replied that BRFSS is already a long survey, so staff have to be
cautious in adding more questions. Despite this, staff are considering posing questions
about Rn testing and CO alarms.
80
David DeGroote asked whether staff knew where the untested wells are located in
Minnesota. Is there any relationship between where those wells are and geographic
areas of high arsenic concentrations? Is it possible to set priorities for testing in areas
where the risk of arsenic contamination is higher? These high arsenic areas in
Minnesota would be where you’d want to start testing. Ed replied that the number of
untested wells is way above 100,000 and, although the well management program has a
database of untested wells, he was not sure that the database has a record of their
locations. Staff are considering targeting areas of high arsenic concentrations for
additional testing of existing wells.
Tracking updates
Panel members had no questions or comments on the tracking updates.
New business
Panel members did not propose any new business to discuss.
Audience questions
Pat asked whether anyone in the audience had questions, but time being tight, received
none.
Motion to adjourn
Pat invited a motion to adjourn, and received both a motion and a seconding of the
motion. The meeting then adjourned.
The next Advisory Panel meeting will be held on Tuesday, October 8, from 1:00 to 4:00
in the afternoon at the American Lung Association-Minnesota, courtesy of Jill Heins
Nesvold.
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Environmental Health Tracking & Biomonitoring Advisory Panel Roster
As of October 2013
Bruce Alexander, PhD
University of Minnesota School of Public
Health
Environmental Health Sciences Division
MMC 807 Mayo
420 Delaware Street SE
Minneapolis, Minnesota 55455
612-625-7934
[email protected]
At-large representative
Fred Anderson, MPH
Washington County
Department of Public Health and
Environment
14949 62nd St N
Stillwater MN 55082
651-430-6655
[email protected]
At-large representative
Alan Bender, DVM, PhD
Minnesota Department of Health
Health Promotion and Chronic Disease
Division
85 East 7th Place
PO Box 64882
Saint Paul, MN 55164-0882
651-201-5882
[email protected]
MDH appointee
David DeGroote, PhD
St. Cloud State University
740 4th Street South
St. Cloud, MN 56301
320-308-2192
[email protected]
Minnesota House of Representatives
appointee
Melanie Ferris
Wilder Foundation
451 Lexington Parkway N
St. Paul, MN 55104
651-280-2660
[email protected]
Nongovernmental organization
representative
Thomas Hawkinson, MS, CIH, CSP
Toro Company
8111 Lyndale Avenue S
Bloomington, MN 55420
[email protected]
952-887-8080
Statewide business org representative
Jill Heins Nesvold, MS
American Lung Association of
Minnesota
490 Concordia Avenue
St. Paul, Minnesota 55103
651-223-9578
[email protected]
Nongovernmental organization
representative
83
Patricia McGovern, PhD, MPH
University of Minnesota School of Public
Health
Environmental Health Sciences Division
MMC Mayo 807
420 Delaware St SE
Minneapolis MN 55455
612-625-7429
[email protected]
University of Minnesota representative
Geary Olsen, DVM, PhD
3M Medical Department
Corporate Occupational Medicine
MS 220-6W-08
St. Paul, Minnesota 55144-1000
651-737-8569
[email protected]
Statewide business organization
representative
Gregory Pratt, PhD
Minnesota Pollution Control Agency
Environmental Analysis and Outcomes
Division
520 Lafayette Road
St. Paul, MN 55155-4194
651-757-2655
[email protected]
MPCA appointee
Cathy Villas-Horns, MS, PG
Minnesota Department of Agriculture
Pesticide and Fertilizer Management
Division
625 Robert Street North
St. Paul, Minnesota 55155-2538
651-201-6291
[email protected]
MDA appointee
Lisa Yost, MPH, DABT
ENVIRON International Corporation
333 West Wacker Drive, Suite 2700
Chicago, IL 60606
Local office
886 Osceola Avenue
St. Paul, Minnesota
55105
Phone: 651-225-1592
Cell: 651-470-9284
[email protected]
At-large representative
Vacant
Minnesota Senate appointee
84
Biographical sketches of advisory panel members
Bruce H. Alexander is a Professor in the Division of Environmental Health Sciences at the
University of Minnesota’s School of Public Health. Dr. Alexander is an environmental and
occupational epidemiologist with expertise in cancer, reproductive health, respiratory
disease, injury, exposure assessment, and use of biological markers in public health
applications.
Fred Anderson is an epidemiologist at the Washington County Department of Public
Health and Environment and has over 30 years of public health experience. .He holds a
Master of Public Health (MPH) in environmental and infectious disease epidemiology
from the University of Minnesota and is a registered environmental health specialist. For
over 20 years, he has led county-wide disease surveillance and intervention programs,
including numerous multidisciplinary epidemiologic investigations.
Alan Bender is the Section Chief of Chronic Disease and Environmental Epidemiology at
the Minnesota Department of Health. He holds a Doctor of Veterinary Medicine degree from
the University of Minnesota and a PhD in Epidemiology from Ohio State University. His work
has focused on developing statewide surveillance systems, including cancer and occupational
health, and exploring the links between occupational and environmental exposures and chronic
disease and mortality.
David DeGroote is Dean of the College of Science and Engineering and Professor of
Biological Sciences at St. Cloud State University. He has been at St. Cloud State University
since 1985, initially as an Assistant Professor in Biological Sciences. He served as
Department Chair from 1996 to 2003 before moving to the Dean’s Office. Most recently
he had focused on providing up-to-date academic programming and facilities that serve
the needs of Minnesota employers in the health sciences, engineering, computing,
biosciences, and STEM education.
Melanie Ferris is a Research Scientist at Wilder Research, a nonprofit research
organization based in St. Paul, Minnesota. She conducts a variety of program evaluation
and applied research projects focused primarily on public health and mental health. She
has worked on a number of recent projects that focus on identifying disparities across
populations and using existing data sources to develop meaningful indicators of health
and wellness. Examples of these projects include a study of health inequities in the Twin
Cities region related to income, race, and place, development of a dashboard of mental
health and wellness indicators for youth living in Hennepin County, and work on local
community health needs assessments. She has a Master’s of Public Health degree in
Community Health Education from the University of Minnesota’s School of Public Health.
85
Tom Hawkinson is the Corporate Environmental, Health, and Safety Manager for the Toro
Company in Bloomington, MN. He completed his MS in Public Health at the University of
Minnesota, with a specialization in industrial hygiene. He is certified in the comprehensive
practice of industrial hygiene and a certified safety professional. He has worked in EHS
management at a number of Twin Cities based companies, conducting industrial hygiene
investigations of workplace contaminants and done environmental investigations of subsurface
contamination both in the United States and Europe. He has taught statistics and mathematics
at both graduate and undergraduate levels as an adjunct, and is on the faculty at the Midwest
Center for Occupational Health and Safety A NIOSH-Sponsored Education and Research Center
School of Public Health, University of Minnesota.
Jill Heins Nesvold serves as the Director of the Respiratory Health Division for the American
Lung Association in Iowa, Minnesota, North Dakota, and South Dakota. Her responsibilities
include program oversight and evaluation related to asthma, chronic obstructive lung disease
(COPD), lung cancer, and influenza. Jill holds a master’s degree in health management and a
short-course master’s of business administration. Jill has published extensively in a variety of
public health areas.
Pat McGovern is a Professor in the Division of Environmental Health Sciences at
the University of Minnesota’s School of Public Health. Dr. McGovern is a health
services researcher and nurse with expertise in environmental and occupational
health policy and health outcomes research. She serves as the Principal
Investigator for the National Children’s Study (NCS) Center serving Ramsey
County, one of 105 study locations nationwide. The NCS is the largest, long-term
study of children’s health and development in the US and the assessment of
environmental exposures will include data collection from surveys, biological
specimens and environmental samples.
Geary Olsen is a corporate scientist in the Medical Department of the 3M Company. He
obtained a Doctor of Veterinary Medicine (DVM) degree from the University of Illinois
and a Master of Public Health (MPH) in veterinary public health and PhD in epidemiology
from the University of Minnesota. For 27 years he has been engaged in a variety of
occupational and environmental epidemiology research studies while employed at Dow
Chemical and, since 1995, at 3M. His primary research activities at 3M have involved the
epidemiology, biomonitoring (occupational and general population), and
pharmacokinetics of perfluorochemicals.
Greg Pratt is a research scientist at the Minnesota Pollution Control Agency. He holds a
Ph.D. from the University of Minnesota in Plant Physiology where he worked on the
effects of air pollution on vegetation. Since 1984 he has worked for the MPCA on a wide
variety of issues including acid deposition, stratospheric ozone depletion, climate change,
atmospheric fate and dispersion of air pollution, monitoring and occurrence of air
pollution, statewide modeling of air pollution risks, and personal exposure to air
pollution. He is presently cooperating with the Minnesota Department of Health on a
86
research project on the Development of Environmental Health Outcome Indicators: Air
Quality Improvements and Community Health Impacts.
Cathy Villas Horns is the Hydrologist Supervisor of the Incident Response Unit (IRU)
within the Pesticide and Fertilizer Management Unit of the Minnesota Department of
Agriculture. Cathy holds a Master of Science in Geology from the University of Delaware
and a Bachelor of Science in Geology from Carleton College and is a licensed Professional
Geologist in MN. The IRU oversees or conducts the investigation and cleanup of point
source releases of agricultural chemicals (fertilizers and pesticides including herbicides,
insecticides, fungicides, etc. as well as wood treatment chemicals) through several
different programs. Cathy has worked on complex sites with Minnesota Department of
Health and MPCA staff, and continues to work with interagency committees on
contaminant issues. She previously worked as a senior hydrogeologist within the IRU, and
as a hydrogeologist at the Minnesota Pollution Control Agency and an environmental
consulting firm.
Lisa Yost is a Principal Consultant at ENVIRON, an international consulting firm. She is in
their Health Sciences Group, and is based in Saint Paul, Minnesota. Ms. Yost completed
her training at the University of Michigan’s School of Public Health and is a board-certified
toxicologist with expertise in evaluating human health risks associated with substances in
soil, water, and the food chain. She has conducted or supervised risk assessments under
CERCLA, RCRA, or state-led regulatory contexts involving a wide range of chemicals and
exposure situations. Her areas of specialization include exposure and risk assessment, risk
communication, and the toxicology of such chemicals as PCDDs and PCDFs, PCBs,
pentachlorophenol (PCP), trichloroethylene (TCE), mercury, and arsenic. Ms. Yost is a
recognized expert in risk assessment and has collaborated in original research on
exposure issues, including background dietary intake of inorganic arsenic. She is currently
assisting in a number of projects, including a complex multi-pathway risk assessment for
PDDD/Fs that will integrate extensive biomonitoring data collected by the University of
Michigan. Ms. Yost is also an Adjunct Instructor at the University of Minnesota’s School of
Public Health.
87
Staff biosketches
Wendy Brunner, PhD, serves as surveillance epidemiologist for the MDH Asthma Program
since 2002, and joined the MN EPHT program on a part-time basis in fall 2009. Previously,
she worked on occupational respiratory disease studies for MDH. She has a masters
degree in Science and Technology Studies from Rensselaer Polytechnic Institute and a
masters degree in Environmental and Occupational Health from the University of
Minnesota. She is currently a doctoral student in the Division of Epidemiology and
Community Health at the University of Minnesota.
Betsy Edhlund, PhD, is a research scientist in the Environmental Section of the Public
Health Laboratory at the Minnesota Department of Health. She works in the metals
laboratory developing methods and analyzing samples for both biomonitoring programs
and emergency response. Betsy received her PhD in chemistry from the University of
Minnesota where her research focused on the photochemistry of natural waters.
Jean Johnson, PhD, MS, is Program Director/Principal Investigator for Minnesota’s
Environmental Public Health Tracking and Biomonitoring Program. Dr. Johnson received
her Ph.D. and M.S. degrees from the University of Minnesota, School of Public Health in
Environmental Health and has 25 years of experience working with the state of
Minnesota in the environmental health field. As an environmental epidemiologist at
MDH, her work has focused on special investigations of population exposure and health,
including studies of chronic diseases related to air pollution and asbestos exposure, and
exposure to drinking water contaminants. She is currently the Principal Investigator on an
EPA grant to develop methods for measuring the public health impacts of population
exposure to particulate matter (PM) in air. She is also an adjunct faculty member at the
University of Minnesota School of Public Heath.
Mary Jeanne Levitt, MBC, is the communications coordinator with the Minnesota
Environmental Public Health Tracking program. She has a Masters in Business
Communications and has worked for over 20 years in both the public and non-profit
sector in project management of research and training grants, communications and
marketing strategies, focus groups and evaluations of educational needs of public health
professionals. She serves on 3 institutional review boards which specialize in academic
research, oncology research, and overall clinical research.
Paula Lindgren, MS, received her Master of Science degree in Biostatistics from the
University of Minnesota. She works for the Minnesota Department of Health as a
biostatistician, and provides statistical and technical support to the MN EPHT and
Biomonitoring programs for data reports, publications, web-based portal dissemination
and presentations in the Chronic Disease and Environmental Epidemiology section. Ms.
Lindgren has also received training in the area of GIS for chronic disease mapping and
analysis. In addition to her work for MN EPHT, she works for various programs within
Chronic Disease and Environmental Epidemiology including the Asthma program, Center
88
for Occupational Health and Safety, Minnesota Cancer Surveillance System, and Cancer
Control section.
Barbara Scott Murdock, MA, MPH, is the Program Planner for the Environmental Public
Health Tracking and Biomonitoring (EHTB) program, responsible for leading strategic
planning and communications with stakeholders and the EHTB Advisory Panel. A biologist
and public health professional by education, she has over 30 years of experience in
writing and editing professional publications. Recently a grants coordinator/writer for
social science faculty at the University of Minnesota, she also served as the biomonitoring
project manager at the Minnesota Department of Health (2001-2003); senior research
fellow in the Center for Environment & Health Policy, UMN School of Public Health (19952001); director of water and health programs at the Freshwater Foundation (1991-1992);
and founding editor of the Health & Environment Digest, a peer-reviewed publication for
environmental health and management professionals in the US and Canada (1986-1992).
She holds a BS in biochemistry from the University of Chicago, an MA in zoology from
Duke University, and an MPH from the University of Minnesota.
Jessica Nelson, PhD, is an epidemiologist with the Minnesota Environmental Public
Health Tracking and Biomonitoring Program, working primarily on design, coordination,
and analysis of biomonitoring projects. Jessica received her PhD and MPH in
Environmental Health from the Boston University School of Public Health where her
research involved the epidemiologic analysis of biomonitoring data on
perfluorochemicals. Jessica was the coordinator of the Boston Consensus Conference on
Biomonitoring, a project that gathered input and recommendations on the practice and
uses of biomonitoring from a group of Boston-area lay people.
Christina Rosebush, MPH, is an epidemiologist with the Minnesota Environmental Public
Health Tracking and Biomonitoring Program. Her work includes the development and
coordination of biomonitoring projects that assess perfluorochemicals (PFCs) and
mercury in Minnesota communities, and collection and statistical analysis of public health
surveillance data for EPHT, with a focus on behavioral risk factors. Christina received her
Master’s degree in epidemiology from the University of Minnesota’s School of Public
Health, completing research in PFC biomonitoring for the Minnesota Department of
Health in partial fulfillment of her degree.
Jeannette M. Sample, MPH, is an epidemiologist with the Minnesota Environmental
Public Health Tracking program at the Minnesota Department of Health, working
primarily with the collection and statistical analysis of public health surveillance data for
EPHT. She also works on research collaborations with academic partners relating to
reproductive outcomes and birth defects. Prior to joining EPHT, she was a CSTE/CDC
Applied Epidemiology Fellow with the MDH Birth Defect Information System. Jeannette
received her Master’s degree in epidemiology and biostatistics from The George
Washington University in Washington, DC.
89
Blair Sevcik, MPH, is an epidemiologist with the Minnesota Environmental Public Health
Tracking (EPHT) program at the Minnesota Department of Health, where she works on
the collection and statistical analysis of public health surveillance data for EPHT. Prior to
joining EPHT in January 2009, she was a student worker with the MDH Asthma Program.
She received her Master’s of Public Health degree in epidemiology from University of
Minnesota School of Public Health in December 2010.
Chuck Stroebel, MSPH, is the MN EPHT Program Manager. He provides day-to-day
direction for program activities, including: 1) development and implementation of the
state network, 2) development and transport of NCDMs and metadata for the national
network, and 3) collaboration and communication with key EPHT partners and
stakeholders. Chuck received a Master’s of Public Health in Environmental Health
Sciences from the University of North Carolina (Chapel Hill). He has over 15 years of
expertise in environmental health, including areas of air quality, pesticides, climate
change, risk assessment, and toxicology. Chuck also played a key role in early initiatives
to build tracking capacity at the Minnesota Department of Health. Currently, he is a
member of the IBIS Steering Committee (state network), the MDH ASTHO Grant Steering
Committee (climate change), and the Northland Society of Toxicology. He also serves on
the MN EPHT Technical and Communications Teams.
Allan N. Williams, MPH, PhD, is an environmental and occupational epidemiologist in the
Chronic Disease and Environmental Epidemiology Section at the Minnesota Department
of Health. He is the supervisor for the MDH Center for Occupational Health and Safety,
which currently includes both the state-funded and federally-funded Environmental
Public Health Tracking and Biomonitoring programs. For over 25 years, he has worked on
issues relating to environmental and occupational cancer, cancer clusters, work-related
respiratory diseases, and the surveillance and prevention of work-related injuries among
adolescents. He has served as the PI on two NIOSH R01 grants, as a co-investigator on
four other federally-funded studies in environmental or occupational health, and is an
adjunct faculty member in the University of Minnesota’s School of Public Health. He
received an MA in Biology from Indiana University, an MPH in Environmental Health and
Epidemiology from the University of Minnesota, and a PhD in Environmental and
Occupational Health from the University of Minnesota
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Environmental Health Tracking and Biomonitoring Statute
$1,000,000 each year is for environmental
health tracking and biomonitoring. Of this
amount, $900,000 each year is for transfer to
the Minnesota Department of Health. The base
appropriation for this program for fiscal year
2010 and later is $500,000.
144.995 DEFINITIONS; ENVIRONMENTAL
HEALTH TRACKING AND BIOMONITORING.
(a) For purposes of sections 144.995 to
144.998, the terms in this section have the
meanings given.
(b) "Advisory panel" means the Environmental
Health Tracking and Biomonitoring Advisory
Panel established under section 144.998.
(c) "Biomonitoring" means the process by
which chemicals and their metabolites are
identified and measured within a biospecimen.
(d) "Biospecimen" means a sample of human
fluid, serum, or tissue that is reasonably
available as a medium to measure the presence
and concentration of chemicals or their
metabolites in a human body.
(e) "Commissioner" means the commissioner
of the Department of Health.
(f) "Community" means geographically or
nongeographically based populations that may
participate in the biomonitoring program. A
"nongeographical community" includes, but is
not limited to, populations that may share a
common chemical exposure through similar
occupations, populations experiencing a
common health outcome that may be linked to
chemical exposures, populations that may
experience similar chemical exposures because
of comparable consumption, lifestyle, product
use, and subpopulations that share ethnicity,
age, or gender.
(g) "Department" means the Department of
Health.
(h) "Designated chemicals" means those
chemicals that are known to, or strongly
suspected of, adversely impacting human health
or development, based upon scientific, peerreviewed animal, human, or in vitro studies, and
baseline human exposure data, and consists of
chemical families or metabolites that are
included in the federal Centers for Disease
Control and Prevention studies that are known
collectively as the National Reports on Human
Exposure to Environmental Chemicals Program
and any substances specified by the
commissioner after receiving recommendations
under section 144.998, subdivision 3, clause (6).
(i) "Environmental hazard" means a chemical
or other substance for which scientific, peerreviewed studies of humans, animals, or cells
have demonstrated that the chemical is known
or reasonably anticipated to adversely impact
human health.
(j) "Environmental health tracking" means
collection, integration, analysis, and
dissemination of data on human exposures to
chemicals in the environment and on diseases
potentially caused or aggravated by those
chemicals.
144.996 ENVIRONMENTAL HEALTH TRACKING;
BIOMONITORING.
Subdivision 1. Environmental health tracking.
In cooperation with the commissioner of the
Pollution Control Agency, the commissioner
shall establish an environmental health tracking
program to:
(1) coordinate data collection with the
Pollution Control Agency, Department of
Agriculture, University of Minnesota, and any
other relevant state agency and work to
promote the sharing of and access to health and
environmental databases to develop an
environmental health tracking system for
Minnesota, consistent with applicable data
practices laws;
(2) facilitate the dissemination of aggregate
public health tracking data to the public and
researchers in accessible format;
(3) develop a strategic plan that includes a
mission statement, the identification of core
priorities for research and epidemiologic
surveillance, and the identification of internal
and external stakeholders, and a work plan
describing future program development and
addressing issues having to do with
compatibility with the Centers for Disease
Control and Prevention's National
Environmental Public Health Tracking Program;
(4) develop written data sharing agreements
as needed with the Pollution Control Agency,
Department of Agriculture, and other relevant
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state agencies and organizations, and develop
additional procedures as needed to protect
individual privacy;
(5) organize, analyze, and interpret available
data, in order to:
(i) characterize statewide and localized trends
and geographic patterns of population-based
measures of chronic diseases including, but not
limited to, cancer, respiratory diseases,
reproductive problems, birth defects, neurologic
diseases, and developmental disorders;
(ii) characterize statewide and localized trends
and geographic patterns in the occurrence of
environmental hazards and exposures;
(iii) assess the feasibility of integrating disease
rate data with indicators of exposure to the
selected environmental hazards such as
biomonitoring data, and other health and
environmental data;
(iv) incorporate newly collected and existing
health tracking and biomonitoring data into
efforts to identify communities with elevated
rates of chronic disease, higher likelihood of
exposure to environmental hazards, or both;
(v) analyze occurrence of environmental
hazards, exposures, and diseases with relation
to socioeconomic status, race, and ethnicity;
(vi) develop and implement targeted plans to
conduct more intensive health tracking and
biomonitoring among communities; and
(vii) work with the Pollution Control Agency,
the Department of Agriculture, and other
relevant state agency personnel and
organizations to develop, implement, and
evaluate preventive measures to reduce
elevated rates of diseases and exposures
identified through activities performed under
sections 144.995 to 144.998; and
(6) submit a biennial report to the chairs and
ranking members of the committees with
jurisdiction over environment and health by
January 15, beginning January 15, 2009, on the
status of environmental health tracking
activities and related research programs, with
recommendations for a comprehensive
environmental public health tracking program.
Subd. 2. Biomonitoring. The commissioner
shall:
(1) conduct biomonitoring of communities on
a voluntary basis by collecting and analyzing
biospecimens, as appropriate, to assess
environmental exposures to designated
chemicals;
(2) conduct biomonitoring of pregnant
women and minors on a voluntary basis, when
scientifically appropriate;
(3) communicate findings to the public, and
plan ensuing stages of biomonitoring and
disease tracking work to further develop and
refine the integrated analysis;
(4) share analytical results with the advisory
panel and work with the panel to interpret
results, communicate findings to the public, and
plan ensuing stages of biomonitoring work; and
(5) submit a biennial report to the chairs and
ranking members of the committees with
jurisdiction over environment and health by
January 15, beginning January 15, 2009, on the
status of the biomonitoring program and any
recommendations for improvement.
Subd. 3. Health data. Data collected under
the biomonitoring program are health data
under section 13.3805.
144.997 BIOMONITORING PILOT PROGRAM.
Subdivision 1. Pilot program. With advice
from the advisory panel, and after the program
guidelines in subdivision 4 are developed, the
commissioner shall implement a biomonitoring
pilot program. The program shall collect one
biospecimen from each of the voluntary
participants. The biospecimen selected must be
the biospecimen that most accurately
represents body concentration of the chemical
of interest. Each biospecimen from the
voluntary participants must be analyzed for one
type or class of related chemicals. The
commissioner shall determine the chemical or
class of chemicals to which community
members were most likely exposed. The
program shall collect and assess biospecimens in
accordance with the following:
(1) 30 voluntary participants from each of
three communities that the commissioner
identifies as likely to have been exposed to a
designated chemical;
(2) 100 voluntary participants from each of
two communities:
(i) that the commissioner identifies as likely to
have been exposed to arsenic; and
(ii) that the commissioner identifies as likely
to have been exposed to mercury; and
(3) 100 voluntary participants from each of
two communities that the commissioner
identifies as likely to have been exposed to
perfluorinated chemicals, including
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perfluorobutanoic acid.
Subd. 2. Base program. (a) By January 15,
2008, the commissioner shall submit a report on
the results of the biomonitoring pilot program
to the chairs and ranking members of the
committees with jurisdiction over health and
environment.
(b) Following the conclusion of the pilot
program, the commissioner shall:
(1) work with the advisory panel to assess the
usefulness of continuing biomonitoring among
members of communities assessed during the
pilot program and to identify other communities
and other designated chemicals to be assessed
via biomonitoring;
(2) work with the advisory panel to assess the
pilot program, including but not limited to the
validity and accuracy of the analytical
measurements and adequacy of the guidelines
and protocols;
(3) communicate the results of the pilot
program to the public; and
(4) after consideration of the findings and
recommendations in clauses (1) and (2), and
within the appropriations available, develop and
implement a base program.
Subd. 3. Participation. (a) Participation in the
biomonitoring program by providing
biospecimens is voluntary and requires written,
informed consent. Minors may participate in the
program if a written consent is signed by the
minor's parent or legal guardian. The written
consent must include the information required
to be provided under this subdivision to all
voluntary participants.
(b) All participants shall be evaluated for the
presence of the designated chemical of interest
as a component of the biomonitoring process.
Participants shall be provided with information
and fact sheets about the program's activities
and its findings. Individual participants shall, if
requested, receive their complete results. Any
results provided to participants shall be subject
to the Department of Health Institutional
Review Board protocols and guidelines. When
either physiological or chemical data obtained
from a participant indicate a significant known
health risk, program staff experienced in
communicating biomonitoring results shall
consult with the individual and recommend
follow-up steps, as appropriate. Program
administrators shall receive training in
administering the program in an ethical,
culturally sensitive, participatory, and
community-based manner.
Subd. 4. Program guidelines. (a) The
commissioner, in consultation with the advisory
panel, shall develop:
(1) protocols or program guidelines that
address the science and practice of
biomonitoring to be utilized and procedures for
changing those protocols to incorporate new
and more accurate or efficient technologies as
they become available. The commissioner and
the advisory panel shall be guided by protocols
and guidelines developed by the Centers for
Disease Control and Prevention and the
National Biomonitoring Program;
(2) guidelines for ensuring the privacy of
information; informed consent; follow-up
counseling and support; and communicating
findings to participants, communities, and the
general public. The informed consent used for
the program must meet the informed consent
protocols developed by the National Institutes
of Health;
(3) educational and outreach materials that
are culturally appropriate for dissemination to
program participants and communities. Priority
shall be given to the development of materials
specifically designed to ensure that parents are
informed about all of the benefits of
breastfeeding so that the program does not
result in an unjustified fear of toxins in breast
milk, which might inadvertently lead parents to
avoid breastfeeding. The materials shall
communicate relevant scientific findings; data
on the accumulation of pollutants to community
health; and the required responses by local,
state, and other governmental entities in
regulating toxicant exposures;
(4) a training program that is culturally
sensitive specifically for health care providers,
health educators, and other program
administrators;
(5) a designation process for state and private
laboratories that are qualified to analyze
biospecimens and report the findings; and
(6) a method for informing affected
communities and local governments
representing those communities concerning
biomonitoring activities and for receiving
comments from citizens concerning those
activities.
(b) The commissioner may enter into
contractual agreements with health clinics,
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community-based organizations, or experts in a
particular field to perform any of the activities
described under this section.
144.998 ENVIRONMENTAL HEALTH TRACKING
AND BIOMONITORING ADVISORY PANEL.
Subdivision 1. Creation. The commissioner
shall establish the Environmental Health
Tracking and Biomonitoring Advisory Panel. The
commissioner shall appoint, from the panel's
membership, a chair. The panel shall meet as
often as it deems necessary but, at a minimum,
on a quarterly basis. Members of the panel shall
serve without compensation but shall be
reimbursed for travel and other necessary
expenses incurred through performance of their
duties. Members appointed by the
commissioner are appointed for a three-year
term and may be reappointed. Legislative
appointees serve at the pleasure of the
appointing authority.
Subd. 2. Members. (a) The commissioner shall
appoint eight members, none of whom may be
lobbyists registered under chapter 10A, who
have backgrounds or training in designing,
implementing, and interpreting health tracking
and biomonitoring studies or in related fields of
science, including epidemiology, biostatistics,
environmental health, laboratory sciences,
occupational health, industrial hygiene,
toxicology, and public health, including:
(1) at least two scientists representative of
each of the following:
(i) nongovernmental organizations with a
focus on environmental health, environmental
justice, children's health, or on specific chronic
diseases; and
(ii) statewide business organizations; and
(2) at least one scientist who is a
representative of the University of Minnesota.
(b) Two citizen panel members meeting the
scientific qualifications in paragraph (a) shall be
appointed, one by the speaker of the house and
one by the senate majority leader.
(c) In addition, one representative each shall
be appointed by the commissioners of the
Pollution Control Agency and the Department of
Agriculture, and by the commissioner of health
to represent the department's Health
Promotion and Chronic Disease Division.
Subd. 3. Duties. The advisory panel shall make
recommendations to the commissioner and the
legislature on:
(1) priorities for health tracking;
(2) priorities for biomonitoring that are based
on sound science and practice, and that will
advance the state of public health in Minnesota;
(3) specific chronic diseases to study under
the environmental health tracking system;
(4) specific environmental hazard exposures
to study under the environmental health
tracking system, with the agreement of at least
nine of the advisory panel members;
(5) specific communities and geographic areas
on which to focus environmental health tracking
and biomonitoring efforts;
(6) specific chemicals to study under the
biomonitoring program, with the agreement of
at least nine of the advisory panel members; in
making these recommendations, the panel may
consider the following criteria:
(i) the degree of potential exposure to the
public or specific subgroups, including, but not
limited to, occupational;
(ii) the likelihood of a chemical being a
carcinogen or toxicant based on peer-reviewed
health data, the chemical structure, or the
toxicology of chemically related compounds;
(iii) the limits of laboratory detection for the
chemical, including the ability to detect the
chemical at low enough levels that could be
expected in the general population;
(iv) exposure or potential exposure to the
public or specific subgroups;
(v) the known or suspected health effects
resulting from the same level of exposure based
on peer-reviewed scientific studies;
(vi) the need to assess the efficacy of public
health actions to reduce exposure to a chemical;
(vii) the availability of a biomonitoring
analytical method with adequate accuracy,
precision, sensitivity, specificity, and speed;
(viii) the availability of adequate biospecimen
samples; or
(ix) other criteria that the panel may agree to;
and
(7) other aspects of the design,
implementation, and evaluation of the
environmental health tracking and
biomonitoring system, including, but not limited
to:
(i) identifying possible community partners
and sources of additional public or private
funding;
(ii) developing outreach and educational
methods and materials; and
94
(iii) disseminating environmental health
tracking and biomonitoring findings to the
public.
Subd. 4. Liability. No member of the panel
shall be held civilly or criminally liable for an act
or omission by that person if the act or omission
was in good faith and within the scope of the
member's responsibilities under sections
144.995 to 144.998.
INFORMATION SHARING.
On or before August 1, 2007, the
commissioner of health, the Pollution Control
Agency, and the University of Minnesota are
requested to jointly develop and sign a
memorandum of understanding declaring their
intent to share new and existing environmental
hazard, exposure, and health outcome data,
within applicable data privacy laws, and to
cooperate and communicate effectively to
ensure sufficient clarity and understanding of
the data by divisions and offices within both
departments. The signed memorandum of
understanding shall be reported to the chairs
and ranking members of the senate and house
of representatives committees having
jurisdiction over judiciary, environment, and
health and human services.
Effective date: July 1, 2007
This document contains Minnesota Statutes,
sections 144.995 to 144.998, as these sections
were adopted in Minnesota Session Laws 2007,
chapter 57, article 1, sections 143 to 146. The
appropriation related to these statutes is in
chapter 57, article 1, section 3, subdivision 4.
The paragraph about information sharing is in
chapter 57, article 1, section 169. The following
is a link to chapter 57:
http://ros.leg.mn/bin/getpub.php?type=law&ye
ar=2007&sn=0&num=57
Current Appropriation for EHTB (see
bolded text on page 96):
Office of the Revisor of Statutes
88th Legislature, 2013, Regular Session,
Chapter 114 Minnesota Session Laws
Subd.
2.Water
25,453,000
25,454,000
Appropriations by Fund
General
State Government
Special Revenue
Environmental
3,737,000
3,737,000
75,000
75,000
21,641,000 21,642,000
$1,959,000 the first year and $1,959,000 the
second year are for grants to delegated
counties to administer the county feedlot
program under Minnesota Statutes, section
116.0711, subdivisions 2 and 3. By January
15, 2016, the commissioner shall submit a
report detailing the results achieved with
this appropriation to the chairs and ranking
minority members at the senate and house of
representatives committees and divisions
with jurisdiction over environment and
natural resources policy and finance. Money
remaining after the first year is available for
the second year.
$740,000 the first year and $740,000 the
second year are from the environmental fund
to address the need for continued increased
activity in the areas of new technology
review, technical assistance for local
governments, and enforcement
under Minnesota Statutes, sections 115.55 to
115.58, and to complete the requirements of
Laws 2003, chapter 128, article 1, section
165.
$400,000 the first year and $400,000
the second year are for the clean water
partnership program. Any unexpended
balance in the first year does not cancel but
is available in the second year. Priority shall
be given to projects preventing impairments
and degradation of lakes, rivers, streams,
and groundwater according to Minnesota
95
Statutes, section 114D.20, subdivision 2,
clause (4).
$664,000 the first year and $664,000 the
second year are from the environmental fund
for subsurface sewage treatment system
(SSTS) program administration and
community technical assistance and
education, including grants and technical
assistance to communities for water quality
protection. Of this amount, $129,000 each
year is for assistance to counties through
grants for SSTS program administration.
A county receiving a grant from this
appropriation shall submit the results
achieved with the grant to the commissioner
as part of its annual SSTS report. Any
unexpended balance in the first year does
not cancel but is available in the second
year.$105,000 the first year and $105,000
the second year are from the environmental
fund for registration of wastewater
laboratories.
$913,000 the first year and $913,000
the second year are from the
environmental fund to continue
perfluorochemical biomonitoring
in eastern metropolitan
communities, as recommended by
the Environmental Health Tracking
and Biomonitoring Advisory Panel,
and address other environmental
health risks, including air quality. Of
this amount, $812,000 the first year
and $812,000 the second year are for
transfer to the Department of
Health.
Notwithstanding Minnesota Statutes, section
16A.28, the appropriations encumbered on
or before June 30, 2015, as grants or
contracts for SSTS's, surface water and
groundwater assessments, total maximum
daily loads, storm water, and water quality
protection in this subdivision are available
until June 30, 2018.
96
97